Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China.
Department of Radiology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China.
Knee Surg Sports Traumatol Arthrosc. 2022 Jun;30(6):2166-2173. doi: 10.1007/s00167-022-06880-0. Epub 2022 Feb 26.
To compare the mid- to long-term clinical and radiological outcomes of the confluent L-shaped tunnel technique with the Y-graft technique for anatomic lateral ankle ligament reconstruction.
This retrospective study involved 41 patients who underwent lateral ankle ligament reconstruction between 2013 and 2018. Based on the tunnel direction and tendon fixation method at the fibula side, patients were divided into two groups, with 17 patients in the L-shaped tunnel group and 24 patients in the Y-graft group. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner score, and Karlsson score were evaluated and compared preoperatively and at follow-up. Anterior talar translation and talar tilt at stress radiographs, postoperative sprain recurrence, range of motion (ROM) restriction, sensory disturbance, etc., were also collected and compared.
The mean follow-up times were 72 and 42 months for the L-shaped group and Y-graft group, respectively. The median VAS pain score, Tegner score, AOFAS score, Karlsson score significantly improved from a preoperative level in both groups (all with p < 0.01). No significant difference was found between the two groups regarding the changes from preoperatively to postoperatively except for the VAS pain score reduction (1.58 ± 1.58 in the L-shaped group vs. 2.53 ± 1.29 in the Y-graft group, p = 0.035). The incidence of flexion-extension ROM restriction (≥ 5°) was significantly higher in the Y-graft group (41.2%) than in the L-shaped group (12.5%) (p = 0.035).
Both the confluent L-shaped tunnel technique and the Y-graft technique significantly improved symptoms, ankle function, and radiographic outcomes in patients with chronic lateral ankle instability (CLAI) at mid- to long-term follow-up. The confluent L-shaped tunnel technique resulted in lower rates of flexion-extension ROM restriction, while the Y-graft technique showed better VAS pain reduction. This result could provide further evidence for the surgical treatment of CLAI.
III.
比较 L 形隧道技术与 Y 型移植物技术在解剖外侧踝关节韧带重建中的中远期临床和影像学结果。
本回顾性研究纳入了 2013 年至 2018 年间进行外侧踝关节韧带重建的 41 例患者。根据隧道方向和腓骨侧肌腱固定方法，将患者分为两组，L 形隧道组 17 例，Y 型移植物组 24 例。评估并比较术前和随访时的美国矫形足踝协会（AOFAS）评分、视觉模拟评分（VAS）疼痛评分、Tegner 评分和 Karlsson 评分。还收集并比较应力位 X 线片上的距骨前移位和距骨倾斜、术后扭伤复发、活动范围（ROM）受限、感觉障碍等情况。
L 形组和 Y 型移植物组的平均随访时间分别为 72 个月和 42 个月。两组 VAS 疼痛评分、Tegner 评分、AOFAS 评分和 Karlsson 评分均较术前明显改善（均 p<0.01）。两组之间除 VAS 疼痛评分降低外（L 形组 1.58±1.58 分，Y 型移植物组 2.53±1.29 分，p=0.035），从术前到术后的变化无显著差异。Y 型移植物组（41.2%）的屈伸 ROM 受限（≥5°）发生率明显高于 L 形组（12.5%）（p=0.035）。
在慢性外侧踝关节不稳定（CLAI）患者的中远期随访中，L 形隧道技术和 Y 型移植物技术均能显著改善症状、踝关节功能和影像学结果。L 形隧道技术导致的屈伸 ROM 受限发生率较低，而 Y 型移植物技术在减轻 VAS 疼痛方面效果更好。这一结果为 CLAI 的手术治疗提供了进一步的证据。
III 级。
